When you’re depressed, it can feel like you’ll never get out from under its shadow. However, even the most severe depression is a treatable condition. There are many effective ways to deal with depression, including lifestyle changes, therapy, medications, and alternative treatments. Learning about the treatment options will help you decide what measures are most likely to work best for your particular situation and needs.

Are you clinically depressed?

If you identify with several of the following signs and symptoms, and they just won’t go away, you may be suffering from clinical depression.

• You can’t sleep or you sleep too much.

• You can’t concentrate or find that previously easy tasks are now difficult.

• You feel hopeless and helpless.

• You can’t control your negative thoughts, no matter how much you try.

• You have lost your appetite or you can’t stop eating.

• You are much more irritable and short-tempered than usual.

• You have thoughts that life is not worth living.

What is depression?

We all go through ups and downs in our mood. Sadness is a normal reaction to life’s struggles, setbacks, and disappointments. Many people use the word “depression” to explain these kinds of feelings, but clinical depression is much more than just sadness. Some people describe depression as “living in a black hole” or having a feeling of impending doom. However, some depressed people don't feel sad at all — instead, they feel lifeless, empty, and apathetic.

Whatever the symptoms, depression is different from normal sadness in that it engulfs your day-to-day life, interfering with your ability to work, study, eat, sleep, and have fun. The feelings of helplessness, hopelessness, and worthlessness are intense and unrelenting, with little, if any, relief.

Depression varies from person to person, but there are some common signs and symptoms. It’s important to remember that these symptoms can be part of life’s normal lows. But when these symptoms are overwhelming and disabling, it's probably time to seek help.

Common signs and symptoms of depression

Feelings of helplessness and hopelessness. A bleak outlook—nothing will ever get better and there’s nothing you can do to improve your situation. Loss of interest in daily activities. No interest in or ability to enjoy former hobbies, pastimes, social activities, or sex. Appetite or weight changes. Significant weight loss or weight gain—a change of more than 5% of body weight in a month. Sleep changes. Either insomnia, especially waking in the early hours of the morning, or oversleeping (also known as hypersomnia). Psychomotor agitation or retardation. Either feeling “keyed up” and restless or sluggish and physically slowed down. Loss of energy. Feeling fatigued and physically drained. Even small tasks are exhausting or take longer. Self-loathing. Strong feelings of worthlessness or guilt. Harsh criticism of perceived faults and mistakes. Concentration problems. Trouble focusing, making decisions, or remembering things.

Depression in teens

While some depressed teens appear sad, others do not. In fact, irritability—rather than depression—is frequently the predominant symptom in depressed adolescents and teens. A depressed teenager may be hostile, grumpy, or easily lose his or her temper. Unexplained aches and pains are also common symptoms of depression in young people.

Depression in older adults

The difficult changes that many older adults face—such as bereavement, loss of independence, and health problems—can lead to depression, especially in those without a strong support system. However, depression is not a normal part of aging. Older adults tend to complain more about the physical rather than the emotional signs and symptoms of depression, and so the problem often goes unrecognized. Depression in older adults is associated with poor health, a high mortality rate, and an increased risk of suicide, so diagnosis and treatment are extremely important.

Depression in women

Rates of depression in women are twice as high as they are in men. This is due in part to hormonal factors, particularly when it comes to premenstrual syndrome (PMS), premenstrual dysphoric disorder (PMDD), postpartum depression, and perimenopausal depression. As for signs and symptoms, women are more likely than men to experience pronounced feelings of guilt, sleep excessively, overeat, and gain weight. Women are also more likely to suffer from seasonal affective disorder.

Many new mothers suffer from some fleeting form of the “baby blues.” Postpartum depression, in contrast, is a longer lasting and more serious depression triggered, in part, by hormonal changes associated with having a baby. Postpartum depression usually develops soon after delivery, but any depression that occurs within six months of childbirth may be postpartum depression.

Depression in men Depression is a loaded word in our culture. Many associate it, however wrongly, with a sign of weakness and excessive emotion. This is especially true with men. Depressed men are less likely than women to acknowledge feelings of self-loathing and hopelessness. Instead, they tend to complain about fatigue, irritability, sleep problems, and loss of interest in work and hobbies. Other signs and symptoms of depression in men include anger, aggression, violence, reckless behavior, and substance abuse. Even though depression rates for women are twice as high as those in men, men are a higher suicide risk, especially older men.

Types of depression

Depression comes in many shapes and forms. The different types of depression have unique symptoms, causes, and effects. Knowing what type of depression you have can help you manage your symptoms and get the most effective treatments.

Major depression

Major depression, or clinical depression, is characterized by the inability to enjoy life and experience pleasure. The symptoms are constant, ranging from moderate to severe. Left untreated, major depression typically lasts for about six months. Some people experience just a single depressive episode in their lifetime, but more commonly, major depression is a recurring disorder. However, there are many things you can do to support your mood and reduce the risk of recurrence.

Atypical Depression

Atypical depression is a common subtype of major depression. It features a specific symptom pattern, including a temporary mood lift in response to positive events. You may feel better after receiving good news or while out with friends. However, this boost in mood is fleeting. Other symptoms of atypical depression include weight gain, increased appetite, sleeping excessively, a heavy feeling in the arms and legs, and sensitivity to rejection. Atypical depression responds better to some therapies and medications than others, so identifying this subtype can be particularly helpful.

Dysthymia (recurrent, mild depression)

Dysthymia is a type of chronic “low-grade” depression. More days than not, you feel mildly or moderately depressed, although you may have brief periods of normal mood. The symptoms of dysthymia are not as strong as the symptoms of major depression, but they last a long time (at least two years). These chronic symptoms make it very difficult to live life to the fullest or to remember better times. Some people also experience major depressive episodes on top of dysthymia, a condition known as “double depression.” If you suffer from dysthymia, you may feel like you’ve always been depressed. Or you may think that your continuous low mood is “just the way you are.” However, dysthymia can be treated, even if your symptoms have gone unrecognized or untreated for years.

Seasonal affective disorder (SAD)

There’s a reason why so many movies and books portray rainy days and stormy weather as gloomy. Some people get depressed in the fall or winter, when overcast days are frequent and sunlight is limited. This type of depression is called seasonal affective disorder (SAD). Seasonal affective disorder is more common in northern climates and in younger people. Like depression, seasonal affective disorder is treatable. Light therapy, a treatment that involves exposure to bright artificial light, often helps relieve symptoms.

Bipolar Disorder -When Depression is Just One Side of the Problem Bipolar disorder, also known as manic depression, is characterized by cycling mood changes. Episodes of depression alternate with manic episodes, which can include impulsive behavior, hyperactivity, rapid speech, and little to no sleep. Typically, the switch from one mood extreme to the other is gradual, with each manic or depressive episode lasting for at least several weeks. When depressed, a person with bipolar disorder exhibits the usual symptoms of major depression. However, the treatments for bipolar depression are very different. In fact, antidepressants can make bipolar depression worse.

The cause of your depression determines the treatment Understanding the underlying cause of your depression may help you overcome the problem. For example, if you are depressed because of a dead end job, the best treatment might be finding a more satisfying career, not taking an antidepressant. If you are new to an area and feeling lonely and sad, finding new friends at work or through a hobby will probably give you more of a mood boost than going to therapy. In such cases, the depression is remedied by changing the situation.

Causes and risk factors for depression

• Loneliness

• Lack of social support

• Recent stressful life experiences

• Family history of depression

• Marital or relationship problems

• Financial strain

• Early childhood trauma or abuse

• Alcohol or drug abuse

• Unemployment or underemployment

• Health problems or chronic pain

The road to depression recovery

Just as the symptoms and causes of depression are different in different people, so are the ways to feel better. What works for one person might not work for another, and no one treatment is appropriate in all cases. If you recognize the signs of depression in yourself or a loved one, take some time to explore the many treatment options. In most cases, the best approach involves a combination of self-help strategies, lifestyle changes, and professional help.

Make healthy lifestyle changes

Lifestyle changes are not always easy to make, but they can have a big impact on depression. Take a good look at your own lifestyle. What changes could you make to support depression recovery? Self-help strategies that can be very effective include:

• Exercise. Regular exercise provides natural, mood lifting chemical changes in your body. You don’t have to train for a marathon; even a short walk every day will help.

• Nutrition. Eating a regular, balanced diet is important for both your physical and mental health.

• Sleep. Poor sleep has a strong effect on mood. Make getting the right amount of sleep for you a priority.

• Social Support. Strong social networks reduce isolation, a key risk factor for depression. Keep in regular contact with friends and family, or consider joining a class or group. Volunteering is a wonderful way to get social support and help others while also helping yourself. Stress Reduction. Make changes in your life to help manage and reduce stress. Too much stress exacerbates depression and puts you at risk for future depression.

If you suspect that you may be depressed, and lifestyle changes haven’t worked, make an appointment to see your primary care doctor for a thorough checkup. If your depression is the result of medical causes, therapy and antidepressants will do little to help. The depression won’t lift until the underlying health problem is identified and treated.

Your doctor will check for medical conditions that mimic depression, and also make sure you are not taking medications that can cause depression as a side effect. Many medical conditions and medications can cause symptoms of depression, including sadness, fatigue, and the loss of pleasure. Hypothyroidism, or low thyroid, is a particularly common mood buster, especially in women. The more medications you are taking, the more the risk for drug interactions. This is especially important to consider in older adults, who often take many different medications every day.

Psychotherapy for depression

Talk therapy is an extremely effective treatment for depression. Therapy gives you tools to treat depression from a variety of angles. What’s more, what you learn in therapy gives you skills and insight to help prevent depression from coming back.

There are many types of therapy available. Three of the more common methods used in depression include cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy. Often, a blended approach is used.

Some types of therapy teach you practical techniques on how to reframe negative thinking and employ behavioral skills in combating depression. Therapy can also help you work through the root of your depression, helping you understand why you feel a certain way, what your triggers are for depression, and what you can do to stay healthy.

Therapy and “the big picture” in depression treatment

One of the hallmarks of depression is feeling overwhelmed and having trouble focusing. Therapy helps you step back and see what might be contributing to your depression and how you can make changes. Here are some of the “big picture” themes that therapy can help with:

Relationships. Understanding the patterns of your relationships, building better relationships and improving current relationships will help reduce isolation and build social support, important in preventing depression.

Setting healthy boundaries. If you are stressed and overwhelmed, and feel like you just can’t say no, you are more at risk for depression. Setting healthy boundaries in relationships and at work can help relieve stress, and therapy can help you identify and validate what boundaries are right for you.

Handling life’s problems. Talking with a trusted therapist can provide good feedback on more positive ways to handle life’s challenges and problems.

When the going gets tough in therapy... Like house remodeling, taking apart things that haven't worked well in one's life often makes them seem worse before they get better. When therapy seems difficult or painful, don't give up. If you discuss your feelings and reactions honestly with your therapist, it will help you move forward rather than retreat back to your old, less effective ways. However, if the connection with your therapist consistently starts to feel forced or uncomfortable, don’t be afraid to explore other options for therapy as well. A strong trusting relationship is the foundation of good therapy.

Self Help For Your Depression

Self-help tip 1: Cultivate supportive relationships

Getting the support you need plays a big role in lifting the fog of depression and keeping it away. On your own, it can be difficult to maintain perspective and sustain the effort required to beat depression. But the very nature of depression makes it difficult to reach out for help. However, isolation and loneliness make depression even worse, so maintaining your close relationships and social activities are important.

The thought of reaching out to even close family members and friends can seem overwhelming. You may feel ashamed, too exhausted to talk, or guilty for neglecting the relationship. Remind yourself that this is the depression talking. You loved ones care about you and want to help.

Turn to trusted friends and family members. Share what you’re going through with the people you love and trust. Ask for the help and support you need. You may have retreated from your most treasured relationships, but they can get you through this tough time. Try to keep up with social activities even if you don’t feel like it. When you’re depressed, it feels more comfortable to retreat into your shell. But being around other people will make you feel less depressed.

10 tips for reaching out and building relationships Talk to one person about your feelings. Help someone else by volunteering. Have lunch or coffee with a friend. Ask a loved one to check in with you regularly. Accompany someone to the movies, a concert, or a small get-together. Call or email an old friend. Go for a walk with a workout buddy. Schedule a weekly dinner date Meet new people by taking a class or joining a club. Confide in a counselor, therapist, or clergy member.

Self-help tip 2: Take care of yourself

In order to overcome depression, you have to nurture yourself. This includes making time for things you enjoy, asking for help from others, setting limits on what you’re able to do, adopting healthy habits, and scheduling fun activities into your day.

Do things you enjoy (or used to) While you can’t force yourself to have fun or experience pleasure, you can choose to do things that you used to enjoy. Pick up a former hobby or a sport you used to like. Express yourself creatively through music, art, or writing. Go out with friends. Take a day trip to a museum, the mountains, or the ballpark.

Come up with a list of things that you can do for a quick mood boost. Include any strategies, activities, or skills that have helped in the past. The more “tools” for coping with depression, the better. Try and implement a few of these ideas each day, even if you’re feeling good.

Spend some time in nature. List what you like about yourself. Read a good book. Watch a funny movie or TV show. Take a long, hot bath.

Listen to music. Take care of a few small tasks. Play with a pet. Write in your journal. Do something spontaneous.

Push yourself to do things, even when you don’t feel like it. You might be surprised at how much better you feel once you’re out in the world. Even if your depression doesn’t lift immediately, you’ll gradually feel more upbeat and energetic as you make time for fun activities.

Expose yourself to a little sunlight every day. Lack of sunlight can make depression worse. Make sure you’re getting enough. Take a short walk outdoors, have your coffee outside, enjoy an al fresco meal, people-watch on a park bench, or sit out in the garden.

Not only does stress prolong and worsen depression, but it can also trigger it. In order to get over depression and stay well, it’s essential to learn how to minimize and cope with stress.

Identify your stressors. Figure out all the things in your life that are stressing you out. Examples include: work overload, unsupportive relationships, substance abuse, taking on too much, or health problems. Once you’ve identified your stressors, you can make a plan to avoid them or minimize their impact.

Go easy on yourself. Many depressed people are perfectionists, holding themselves to impossibly high standards and then beating themselves up when they fail to meet them. Battle this source of self-imposed stress by challenging your negative ways of thinking.

Plan ahead. If you know your stress triggers and limits, you will be able to identify and avoid many landmines. If you sense trouble ahead, protect yourself by dipping into your wellness toolbox and saying “no” to added responsibility.

Self-help tip 3: Get regular exercise

When you’re depressed, exercising may be the last thing you feel like doing. But exercise is a powerful tool for dealing with depression. In fact, studies show that regular exercise can be as effective as antidepressant medication at increasing energy levels and decreasing feelings of fatigue.

Scientists haven’t figured out exactly why exercise is such a potent antidepressant, but evidence suggests that physical activity increases mood-enhancing neurotransmitters in the brain, raises endorphins, reduces stress, and relieves muscle tension – all things that can have a positive effect on depression. To get the most benefit, aim for 30 minutes of exercise per day. But you can start small.

Short 10-minute bursts of activity can have a positive effect on your mood. Here are a few easy ways to get moving:

Take the stairs rather than the elevator Park your car in the farthest spot in the lot Take your dog for a walk Pair up with an exercise partner Walk while you’re talking on the phone.

As a next step, try incorporating walks or some other enjoyable, easy form of exercise into your daily routine. The key is to pick an activity you enjoy, so you’re more likely to keep up with it.

Exercise as an Antidepressant The following exercise tips offer a powerful prescription for boosting mood: Exercise now…and again. A 10-minute walk can improve your mood for two hours. The key to sustaining mood benefits is to exercise regularly. Choose activities that are moderately intense. Aerobic exercise undoubtedly has mental health benefits, but you don't need to sweat strenuously to see results. Find exercises that are continuous and rhythmic (rather than intermittent). Walking, swimming, dancing, stationery biking, and yoga are good choices. Add a mind-body element. Activities such as yoga and tai chi rest your mind and pump up your energy. You can also add a meditative element to walking or swimming by repeating a mantra (a word or phrase) as you move. Start slowly, and don't overdo it. More isn't better. Athletes who over train, find their moods drop rather than lift.

Self-help tip 4: Eat a healthy, mood-boosting diet

What you eat has a direct impact on the way you feel. Aim for a balanced diet of protein, complex carbohydrates, fruits and vegetables.

Don’t neglect breakfast. A solid breakfast provides energy for the day. Don’t skip meals. Going too long between meals can make you feel irritable and tired, so aim to eat something at least every 3-4 hours. Minimize sugar and refined carbs. You may crave sugary snacks, baked goods, or comfort foods such as pasta or french fries. But these “feel-good” foods quickly lead to a crash in mood and energy. Focus on complex carbohydrates. Foods such as baked potatoes, whole-wheat pasta, brown rice, oatmeal, whole grain breads, and bananas can boost serotonin levels without a crash.

Boost your B vitamins. Deficiencies in B vitamins such as folic acid and B-12 can trigger depression. To get more, take a B-complex vitamin supplement or eat more citrus fruit, leafy greens, beans, chicken, and eggs.

Consider taking a chromium supplement – Some depression studies show that chromium picolinate reduces carbohydrate cravings, eases mood swings, and boosts energy. Supplementing with chromium picolinate is especially effective for people who tend to overeat and oversleep when depressed. Aim for 600 mcg per day.

Practice mindful eating. Slow down and pay attention to the full experience of eating. Enjoy the taste of your food.

Self-help tip 5: Challenge negative thinking

Depression puts a negative spin on everything, including the way you see yourself, the situations you encounter, and your expectations for the future.

But you can’t break out of this pessimistic mind frame by “just thinking positive.” Happy thoughts or wishful thinking won’t cut it. Rather, the trick is to replace negative thoughts with more balanced thoughts.

Ways to challenge negative thinking:

Think outside yourself. Ask yourself if you’d say what you’re thinking about yourself to someone else. If not, stop being so hard on yourself. Think about less harsh statements that offer more realistic descriptions.

Keep a “negative thought log”. Whenever you experience a negative thought, jot down the thought and what triggered it in a notebook. Review your log when you’re in a good mood. Consider if the negativity was truly warranted. For a second opinion, you can also ask a friend or therapist to go over your log with you.

Replace negatives with positives. Review your negative thought log. Then, for each negative thought, write down something positive. For instance, “My boss hates me. She gave me this difficult report to complete” could be replaced with, “My boss must have a lot of faith in me to give me so much responsibility.”

Socialize with positive people. Notice how people who always look on the bright side deal with challenges, even minor ones, like not being able to find a parking space. Then consider how you would react in the same situation. Even if you have to pretend, try to adopt their optimism and persistence in the face of difficulty.

Self-help tip 6: Raise your emotional intelligence

Emotions are powerful. They can override thoughts and profoundly influence behavior. But if you are emotionally intelligent, you can harness the power of your emotions.

Emotional intelligence gives you the ability to:

Remain hopeful during challenging and difficult times Manage strong feelings and impulses Quickly rebound from frustration and disappointment Ask for and get support when needed Solve problems in positive, creative ways.

Emotional intelligence isn’t a safety net that protects you from life’s tragedies, frustrations, or disappointments. We all go through disappointments, loss, and change. And while these are normal parts of life, they can still cause sadness, anxiety, and stress. But emotional intelligence gives you the ability to cope and bounce back from adversity, trauma, and loss. In other words, emotional intelligence makes you resilient.

We hope that this handout has been helpful to you. At the Counseling Center of New Smyrna Beach we have several therapist who can assist you in getting the treatment you need. If we can be of help please call 386.423.9161 today. Start living your legacy!